# GEORGIA MOBILE DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437608619
- **Authorized official:** MICHAEL JUBAN DDS (MANAGING MEMBER)
- **Authorized official phone:** (225) 927-8663

## Contact information

- **Practice address:** 8564 JEFFERSON HWY, SUITE A, BATON ROUGE, LA 70809-2197
- **Practice address phone:** (225) 927-8663
- **Mailing address:** 8564 JEFFERSON HWY, SUITE A, BATON ROUGE, LA 70809-2197
- **Mailing address phone:** (225) 927-8663

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 09/28/2016
- **Last updated:** 09/28/2016